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Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI,1 Hospital General de Zona 47,2 Hospital General de Zona 25,3 Hospital General de Zona 27,4 Hospital General de Zona 8,5 Hospital General de Zona 32,6 Instituto Mexicano del Seguro Social, México City, México
Correspondence to: M. Ávila-Diaz, Arboledas 59, colonia Ampliación Insurgentes Cuicuilco, México, D.F., C.P. 04500, México. cramav{at}yahoo.com.mx
Background: Inflammation is an important risk for
mortality in dialysis patients. Extracellular fluid volume (ECFv) expansion, a
condition commonly seen in peritoneal dialysis (PD) patients, may be
associated with inflammation. However, published support for this relationship
is scarce. Objectives: To quantify the proportion of patients on
PD with inflammation and to analyze the role of ECFv expansion and the factors
related to these conditions. Design: A prospective, multicenter cross-sectional
study in six hospitals with a PD program. Patients and Methods: Adult patients on PD were
studied. Clinical data, body composition, and sodium and fluid intake were
recorded. Biochemical analysis, C-reactive protein (CRP), and peritoneal and
urinary fluid and sodium removal were also measured. Results: CRP values positive (
3.0 mg/L) for
inflammation were found in 147 (80.3%) and negative in 36 patients. Patients
with positive CRP had higher ECFv/total body water (TBW) ratio (women 47.69
± 0.69 vs 47.36 ± 0.65, men 43.15 ± 1.14 vs 42.84
± 0.65; p < 0.05), higher serum glucose (125.09 ± 81.90 vs
103.28 ± 43.30 mg/dL, p < 0.03), and lower serum albumin (2.86
± 0.54 vs 3.17 ± 0.38 g/dL, p < 0.001) levels. They also had
lower ultrafiltration (1003 ± 645 vs 1323 ± 413 mL/day, p <
0.005) and total fluid removal (1260 ± 648 vs 1648 ± 496 mL/day,
p < 0.001), and less peritoneal (15.59 ± 162.14 vs 78.11 ±
110.70 mEq/day, p < 0.01) and total sodium removal (42.06 ± 142.49
vs 118.60 ± 69.73 mEq/day, p < 0.001). In the multivariate analysis,
only ECFv/TBW was significantly (p < 0.04) and independently associated
with inflammation. ECFv/TBW was correlated with fluid removal (r = 0.16, p
< 0.03) and renal sodium removal (r = 0.2, p < 0.01). Conclusion: The data suggest that ECFv expansion may
have a significant role as an inflammatory stimulus. The results disclose a
relationship between the two variables, ECFv expansion and inflammation,
identified as independent risk factors for mortality in PD patients.
KEY WORDS: Inflammation; C-reactive protein; extracellular fluid volume; sodium removal; water removal; end-stage renal disease.
Received 30 August 2005; accepted 22 March 2006.
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  M. Kayikcioglu, M. Tumuklu, M. Ozkahya, O. Ozdogan, G. Asci, S. Duman, H. Toz, L. H. Can, A. Basci, and E. Ok The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis Nephrol. Dial. Transplant., November 11, 2008; (2008) gfn599v1. [Abstract] [Full Text] [PDF]
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